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I-4210 Notification of Opportunity for Rebuttal
Revision 09-4; Effective December 1, 2009
If any amount of uncompensated value exists, HHSC informs the person or authorized representative of the amount of uncompensated value and the length of the penalty period. The penalty period applies unless the person provides convincing evidence that the disposal was solely for some purpose other than to obtain Medicaid services. If, within the periods specified in this paragraph, the person or authorized representative makes no effort to rebut the presumption that the transfer was solely to obtain Medicaid services, HHSC will assume that the presumption is valid. The rebuttal period is 10 workdays after written notification.
Notify the person or authorized representative in person or by telephone about the presumption, the amount of uncompensated value and the length of the penalty period. If personal contact cannot be made within three workdays of determination, immediately mail Form H1226, Transfer of Assets/Undue Hardship Notification, to the person or authorized representative.
Note: If the person or authorized representative is contacted in person or by telephone, immediately follow up with a written notice using Form H1226. If a rebuttal is not received within the specified period, determine the impact of the transferred asset on the person's Medicaid.
See Appendix XVI, Documentation and Verification Guide.
I-4220 Rebuttal of the Presumption
Revision 09-4; Effective December 1, 2009
Transfer of assets statutes presume that all transfers for less than fair market value are to obtain Medicaid services. The person or authorized representative is responsible for providing convincing evidence that the transaction in question was exclusively for some other purpose. To rebut the presumption, the person or authorized representative must provide a written statement and any relevant documentation to substantiate the statement. The statement, oral or written, must include at least the following:
- purpose for transferring the asset;
- attempts to dispose of the asset at fair market value;
- reason for accepting less than fair market value for the asset;
- means of or plan for self-support after the transfer; and
- relationship to the person to whom the asset was transferred.
Consider all statements and documentation provided by the person. The person can successfully rebut the presumption that the asset was transferred to obtain Medicaid services only if the person convincingly demonstrates that the asset was transferred exclusively for some other purpose. If the person had some other purpose for transferring the asset but obtaining Medicaid services seems to have also been a factor in the decision to transfer, the presumption is not successfully rebutted.
If a person does not rebut the presumption that the asset was transferred to obtain Medicaid services or if his rebuttal is unsuccessful, consider the uncompensated value of the transferred asset to determine the length of the penalty period for institutional and home/community-based waiver services.
If a person is determined to have successfully rebutted the presumption that the asset was transferred to obtain Medicaid services, the supervisor must review and concur with the decision. Record this concurrence in the case record.
I-4221 Exclusively for Some Purpose Other than to Qualify
Revision 09-4; Effective December 1, 2009
The presence of one or more of the following factors, while not conclusive, may indicate that the asset was transferred exclusively for some purpose other than to qualify for assistance. This list does not include every possible factor.
- After transfer of the asset, one of the following occurs:
- unanticipated drastic change in the person's health, resulting in a greatly increased need for medical care;
- unexpected loss of other resources that would have precluded eligibility; and
- unexpected loss of income that would have precluded eligibility without an income-diversion trust.
- Total resources would have remained below the resource limits since the transfer occurred if the resource was retained.
- The transfer was made as a result of a court order or other legal commitment, such as a judgment or debt owed.